Question: Is it appropriate for a hospital to bill a visit code under the Outpatient Prospective Payment System (OPPS) for care provided to a registered outpatient if the patient was not seen by a physician?
Patient Financial Services Weekly Advisor, October 10, 2008
Answer: Billing a visit code in addition to another service merely because the patient interacted with hospital staff or spent time in a room for that service is inappropriate. A hospital may bill a visit code based on the hospital’s own coding guidelines, which must reasonably relate the intensity of hospital resources to the different levels of HCPCS codes. Services furnished must be medically necessary and documented.
For example, CPT code 85610 (Prothrombin time) is a code that describes performance of the prothrombin time test. If the only service provided is a venipuncture and lab test to determine the prothrombin time, then this is all that should be billed. If a hospital provides a distinct, separately identifiable service in addition to the test, the hospital is responsible for billing the code that most closely describes the service provided. Billing a visit code in addition to another service merely because the patient interacted with hospital staff or spent time in a room for that service is inappropriate. Providers should work with their local FIs regarding the medical necessity for these visits.
Source: Centers for Medicare & Medicaid Services
Comments
0 comments on “Question: Is it appropriate for a hospital to bill a visit code under the Outpatient Prospective Payment System (OPPS) for care provided to a registered outpatient if the patient was not seen by a physician? ”
Related Products
-
Recovery Auditor Report
The Recovery Auditor Report is a free biweekly e-newsletter of useful tips and strategies to get you prepared for the...
-
Medicare Update for CAHs
Medicare Update for CAHs is a free bi-weekly ezxne that provides specialized information for our CAH (critical access...
Most Popular
- Articles
-
- HIPAA Q&A: Answering service messages
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- Q&A: Coding for dry skin due to cold weather
- Q/A: Volume requirement for reporting hydration services
- Are your workforce members texting PHI?
- Topic: CMS, OESS post new security compliance review information, checklist
- What does case-mix index mean to you?
- Privacy, security concerns high in HIEs
- QA:Coding multiple initial infusions
- OB services: Coding inside and outside of the package
- E-mailed
-
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- Q/A: Volume requirement for reporting hydration services
- HIPAA Q&A: Level of encryption needed for email
- HIPAA Q&A: Answering service messages
- HIPAA Q&A: TPO disclosures to a business associate
- Are your workforce members texting PHI?
- Q&A: Coding for dry skin due to cold weather
- Hospitalist-surgeon comanagement has no effect on outcomes
- Don't let these sentinel events trigger falsely
- Correctly bill ancillary bedside procedures in addition to the room rate
- Searched